Differential Diagnosis for Severe Abdominal Pain with No Abnormal Imaging Findings
Single Most Likely Diagnosis
- Functional abdominal pain: This is a common cause of severe abdominal pain without any identifiable organic cause, often related to stress, anxiety, or other psychological factors. The absence of abnormal imaging findings supports this diagnosis.
Other Likely Diagnoses
- Early appendicitis: Appendicitis can present with severe abdominal pain before any significant abnormalities are visible on imaging studies.
- Gastroenteritis: Inflammation of the stomach and intestines can cause severe abdominal pain, and imaging findings may be normal if the condition is mild or in its early stages.
- Inflammatory bowel disease (IBD): Conditions like Crohn's disease or ulcerative colitis can cause severe abdominal pain, and early in the disease process, imaging may not show significant abnormalities.
- Intestinal obstruction: Early or partial obstruction might not be evident on initial imaging, especially if it's a dynamic process.
Do Not Miss Diagnoses
- Mesenteric ischemia: This is a life-threatening condition that may not show up on initial imaging. It requires a high index of suspicion, especially in patients with risk factors such as atrial fibrillation or a history of vascular disease.
- Ectopic pregnancy: In women of childbearing age, ectopic pregnancy is a critical diagnosis to consider, as it can present with severe abdominal pain and may not be visible on early ultrasound.
- Ovarian torsion: Another gynecological emergency that can cause severe abdominal pain without clear evidence on initial imaging.
- Pulmonary embolism: Although primarily a respiratory issue, a pulmonary embolism can refer pain to the abdomen, especially if the embolism is large or involves the lung bases.
Rare Diagnoses
- Porphyria: A group of disorders that can cause severe abdominal pain, among other symptoms, without specific findings on imaging.
- Hereditary angioedema: A rare genetic disorder that can cause episodes of severe abdominal pain due to angioedema of the bowel wall, which might not be evident on standard imaging.
- Abdominal migraine: A condition that can cause recurrent episodes of severe abdominal pain, often without any identifiable cause on imaging studies.
- Chronic intermittent intestinal pseudo-obstruction: A rare condition characterized by episodes of intestinal obstruction without any mechanical cause, which can be difficult to diagnose with imaging alone.